Heart Failure And Deaths Among Cardiac Patients Have Halved New Study Says

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Main Category: Cardiovascular / Cardiology
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Article Date: 02 May 2007 - 6:00 PDT

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A new international study suggests the rate of heart failure and death among cardiac patients admitted to hospital has nearly halved in the last 6 years thanks to more effective drugs and treatments.

The observational study, the largest of its kind, is published in the Journal of the American Medican Association (JAMA).

The research, which was led by the University of Edinburgh, analysed hospital data from 1999 to 2006 covering 44,372 patients who were admitted to 113 hospitals in 14 countries with Acute Coronary Symptoms (ACS) such as heart attack and unstable angina.

The results showed that rates of new heart failure and death, and incidence of stroke and heart attack after discharge fell over the first half of this decade.

The countries involved included: Belgium, Britain, Canada, France, Germany, Poland, Spain and the United States. They were enrolled in the Global Registry of Acute Coronary Events (GRACE).

The researchers found that:

-- The death rate for patients admitted with a severe heart attack, where the arteries are completely blocked, went down from 8.4 to 4.5 per cent.
-- The risk of heart failure for severe heart attack patients also went down from 20 to 11 per cent.
-- The death rate for patients admitted with a milder heart attack, where the arteries are only partially blocked, also went down from 2.9 to 2.0 per cent.
-- This equates to 30 fewer deaths and 90 fewer patients with new heart failure per 1,000 hospital admissions.
-- Critical heart failure or "cardiogenic shock", which kills 70 per cent of patients who suffer severe heart attacks, went down from 7.1 to 4.7 per cent among these patients.

This study is the first one to show that heart failure rates are falling as well as deaths.

Heart failure is a chronic, progressive condition where damage to the heart muscle means it can't pump enough blood and the lungs fill up with fluid. Patients are often cared for in the community by specialist nurses.

The researchers also found that after hospital treatment:

-- Both severe and milder heart attack patients were less likely to have strokes or further heart attacks in the ensuing six months.
-- For severe heart attack patients the risk of stroke went down from from 1.3 to 0.5 per cent and further heart attack risk more than halved from 4.8 down to 2.0 per cent.
-- For milder heart attack patients the risk of stroke went down from 1.26 to 0.67 per cent and the risk of a further heart attack went down from 3.0 to 1.9 per cent.

The overall conclusion of the study states that:

"In this multinational observational study, improvements in the management of patients with ACS were associated with significant reductions in the rates of new heart failure and mortality and in rates of stroke and mycoardial infarction at 6 months."

British Heart Foundation professor of cardiology at the University of Edinburgh, Prof Keith A. Fox said:

"We know that advances in medical treatments have improved outcomes due to large scale trials of therapies but there has been a substantial gap in knowing how this relates to how new drugs and procedures are being used and implemented in hospitals."

He said that this study shows that hospitals are using newer drugs and following newer treatment guidelines and this is largely responsible for the reductions:

"Our study enables us to look at differences in practice in a clinical setting over time and it has reflected significant changes in how patients with heart attacks are treated, showing that guidelines are being followed. As a result there is a major reduction in death rates."

In pinning down the specifics, Prof Fox said that beta-blockers, statins, angiotensin-converting enzyme inhibitors (ACE) and various clot-busting drugs count among the newer drugs that hospitals are making more use of now. But, newer drugs on their own do not account for all the long term improvements, which he said must also be due to "acute treatments":

"We have taken into account risk factors and the improved outcomes are not because patients are less unwell when they arrive at hospital," Prof Fox explained.

He said the study confirms that hospitals are using new drugs and procedures effectively and patients have a noticeably lower risk of dying or having another stroke while in hospital and are less likely to have a stroke or another heart attack after they leave.

Medical Director at the British Heart Foundation (BHF), Professor Peter Weissberg, welcomed the findings:

"This is a great example of why long-term investment in heart research is vital. The study shows that fewer people are dying, and fewer are developing debilitating heart failure thanks to research evidence prompting these hospitals to improve the way they treat people with heart disease."

"Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes, 1999-2006."
Keith A. A. Fox; Philippe Gabriel Steg; Kim A. Eagle; Shaun G. Goodman; Frederick A. Anderson, Jr; Christopher B. Granger; Marcus D. Flather; Andrzej Budaj; Ann Quill; Joel M. Gore; for the GRACE Investigators.
JAMA 2007 297: 1892-1900
Vol. 297 No. 17, May 2, 2007

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Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
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